County-run insurance plan eyes new state insurance exchange

Leaders of a Ventura County-run HMO want the insurance plan to participate in the online marketplace being created through the federal health care overhaul.

Officials of the Ventura County Health Care Plan, which covers more than 20,000 people including county employees and people in the government program Healthy Families, will ask the Ventura County Board of Supervisors on Tuesday for approval to apply for a chance to offer coverage through the California Health Benefit Exchange.

Beginning Jan. 1, the exchange will start providing insurance to people not covered by their employers and ineligible for coverage through a Medi-Cal program set to expand next year.

County health care leaders say they're primarily interested in the more than 40,000 people in the county who will receive government subsidies in the exchange, a group that will include people who make as much as $44,680 a year.

Participation in the exchange is a way to keep people in that group who already use county hospitals and clinics, said Dr. Robert Gonzalez, director of the Ventura County Health Care Agency, which administers the county HMO.

"It represents an opportunity to keep those patients in our medical system," he said, adding that people will be able to choose from several plans in the exchange. He said the request to the Board of Supervisors was a preliminary step in a long process in which the exchange chooses the plans that serve a region of the state.

But the county's intent has raised concerns among some private health care systems. Gary Wilde, CEO of the Community Memorial Health System, said he had no complaints with the county's attempt to keep the patients it serves.

"I do think that behind the scenes there may be a plan to market themselves to a population that is currently not served by the county," said Wilde, leader of a system that includes the nonprofit Community Memorial Hospital in Ventura. "Therein lies the concern of private hospitals and private companies."

In 2001, in an effort to resolve growing conflict between Community Memorial and Ventura County Medical Center, officials reached what was called a "gentleman's business agreement." As part of the deal, county officials said they would not expand their health insurance plan to include private patients.

Gonzalez said participation in the health exchange does not conflict with that agreement. The county plan is interested only in people who receive government subsidies, he said.

"We'd like to be able to continue to see those patients who have always been our patients," he said, projecting that if the number of patients in the plan grows, the gain would be modest.

Wilde said his concerns would increase if the county uses the exchange to get new patients.

"If their plan is to only market to individuals who are currently associated with the county clinics, I have no problem," he said. "I have a huge problem if their intent is greater than that."

Roberto Juarez, CEO of the Clinicas del Camino Real health system, said he shares some of Wilde's worries. Juarez also expressed concern that the county may try to provide all care for any new patients at county clinics and hospitals rather than partner with other systems.

Gonzalez said the county's health insurance plan already partners with other systems, including Clinicas.

"If we're successful in becoming a provider in the health benefit exchange, people will be able to use all the providers that deliver services under the Ventura County Health Care Plan," he said.

The deadline for health plans to apply for the exchange is Jan. 15. People will be able to enroll in the online marketplace starting Oct. 1, and coverage will begin Jan. 1, 2014.

County Supervisor Kathy Long said there have been dramatic changes in health care in the 11 years since the county and Community Memorial reached their agreement. The federal health care overhaul means millions of people who lack coverage now will have insurance starting next year.

The county is adapting to those new realities, she said. "It's a different animal."

Referring to the county health plan's intentions, she said, "It's not like we're offering insurance to the businessman down the street."